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Private obstetrician to supplement public system (QMH) - cervical incompetence risk

  1. #1
    hugs is offline Registered User
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    Private obstetrician to supplement public system (QMH) - cervical incompetence risk

    Hi all! I'm due in September and will be going through the public system at Queen Mary for the birth. This is my first pregnancy and due to a previous cervical cone biopsy I have been told that I am at higher risk for preterm labour. I have a trans-vaginal scan scheduled at QMH for early April to assess the cervix but even if the result is normal I would still like to find a private obstetrician through whom I can get more frequent scans to measure cervical length as the pregnancy progresses.

    I have been looking through the other threads but they have left me slightly confused as it appears that some private obs won't see you unless you are having your baby through them or a specific private hospital.. So I'm looking for someone who will see me even though I'm going public, and preferably also someone who has experience/a good reputation as regards monitoring or intervention for cervical incompetence. Any suggestions would be very helpful!

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    rani's Avatar
    rani is offline Administrator
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    Dr Sally Ferguson Will see you. She's no longer delivering and only doing prenatal care. She used to work at qmh and knows the system. She's now at ot &p

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    luvjoara is offline Registered User
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    Hi Hugs, I had that cone biopsy last year and doesn't queen mary give you a special care? I am planning for a second pregnancy and would like to know if a case like me is put in a special care so that I do not need to see a private doctor additionally...

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    hugs is offline Registered User
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    At tsan yuk/qmh I was actually given the options of a precautionary cervical stitch (cerclage), or extra internal scans to monitor the length of the cervix. I opted for the latter and I have had one so far at qmh - my appointment was 8:30am and I waited 6 hours in the ward to be seen by the doctor - when I finally saw him the cervical length was less than at my last scan (3cm down from 3.5) with the private doctor but he wasn't too interested in this information and I felt he was quite dismissive. I asked about another scan to continue to see if there is any change but he was reluctant to arrange this (although he would have had I kept pushing, I think) and didn't seem to want to discuss anything about my history or why I (and the private doc who I had seen by that point) was concerned.

    In the end, given the waiting time and the less-than-reassuring treatment, for my own peace of mind, I have decided to just go to the basic appointments at Tsan Yuk and pay for the 'extra' scans to be done privately. I'm seeing dr Edwin Tam at OT&P who has been fantastic so far. if you can afford to supplement with private appts I would say do it, as you can get a bit more reassurance and explanation about options and can ensure your case is monitored a little more pro-actively.

  5. #5
    luvjoara is offline Registered User
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    Dear hugs,
    That is so annoying and disappointing.. To tell you about my first delivery, I found it was only 2.2 cm on the 28th week and it was too late for the cerclage. It went shorter by the time of week 33 so I had to lie down until the final week. So if the private doctor says it is okay to not have the cerclage, just be careful, no hard exercise or holding heavy things... Not too many walkings.. I am sure you will be fine. So on which week were you give the cerclage option? And do you still plan to give birth at QM?

  6. #6
    hugs is offline Registered User
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    Hi Luvjoara...yes am still planning to go with QMH - I'm 32 weeks now and have had no problems, thankfully! I saw Dr Tam fortnightly since around 20 weeks and each time the transvaginal ultrasound showed the cervical length was the same (around 3.5cm) and there was no funnelling.
    I am no longer seeing Dr Tam as he explained that past 30 weeks, even if there were some cervical changes/any drastic shortening, they would not intervene to stop labour/put in a stitch because with the right care the survival rate (with no disability) of babies born this early is apparently sufficiently high. I am so glad I went to him though as it was very reassuring each time to know that if there was any indication of a problem, we would catch it early enough to intervene if necessary. He was incredibly patient with his explanations and generous with his time, and I was sad to finish my series of appointments with him! But I will be just going with the regular antenatal appointments at QMH from now on.

    Now I am wondering about the risk of not dilating enough during labour! As I have recently heard that previous cone biopsies and LEEP procedures can leave scarring and result in a c-section after failure to progress during labour, as the scarring prevents your cervix from dilating properly. Which doesn't sound fun but apparently there is no way to tell whether you have significant scarring until you start to dilate. Apparently scar tissue can be broken up 'manually' by a midwife to facilitate a vaginal birth but this is not a usual procedure or very well-known generally (from what I have heard) - so if that is the case I doubt this will be something they will entertain at QMH.

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